364. Perspectives of pregnancy in women with chronic kidney disease: A National Registry Survey Study

Abstract

Background Women with chronic kidney disease (CKD) are at risk of complications in pregnancy. Understanding of the experience of pregnancy for women with chronic kidney disease is limited. Currently, care for many pregnant women with CKD is provided by nephrologists and obstetricians in tertiary centres. This survey will seek to determine care received. The aim of this questionnaire study is to describe variability in care received by women with CKD during and after pregnancy, and explore the impact of model of care delivery on their experiences of care. Methods An online questionnaire was developed and sent to women with CKD who had at least one pregnancy and who had consented to be contacted for research from the UK Rare Renal Diseases Registry (RaDaR), Pre-eclampsia Chronic Hypertension rEnal and SLE study (PEACHES) and Pregnancy Adaptation In Renal disease Study (PAIRS). Results There was a 10% response rate. Most women (90%) were of white ethnicity. Most women had successful pregnancies, however, approximately one in seven women had previously had a fetal or perinatal loss. There were no differences in model of care (joined up or fragmented) according to disease severity. Anxiety for health was similar between women with ‘mild’ and ‘severe’ disease. Fewer women in the fragmented care group found the care by their midwife reassuring. Conclusion Findings suggest variability in care is not necessarily based on disease severity but geography or hospital resource. Women are more satisfied with ‘joined up’ care, supporting a move to MDT care for women with high risk pregnancies as suggest by NICE. The trend toward lower satisfaction levels with midwives when fragmented care is experienced highlights an area of further research needed, with possibly more training for midwives into CKD pregnancies and more integration of midwives into care for these women.